Provider Demographics
NPI:1972685261
Name:LAKIS, ADIB IBRAHIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADIB
Middle Name:IBRAHIM
Last Name:LAKIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:SUITE 472
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:781-821-2120
Mailing Address - Fax:781-821-2433
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:SUITE 472
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:781-821-2120
Practice Address - Fax:781-821-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX10837OtherBLUE CROSS OF MASS
MA380796OtherHPHC